MEDIVAC - EQUITABLE CARE FOR BRITISH COLUMBIANS (2023)

Issue

British Columbia is a geographically large and diverse province with significant rural areas and communities not within a reasonable distance to enable access to medical services that should be available to all British Columbians.

Access isn’t just a community issue for the people living in rural and remote communities, it’s a business issue for companies in those communities. Access to health services and/or medivac services, if needed, go a long way to help businesses in rural and remote communities to recruit and retain workers. These kinds of services also help rural and remote communities to attract and retain businesses and industry – a vital part of economic development.

Background

All British Columbians should have access to equitable health care. Section 12(a) of the Canada Health Act – Accessibility stipulates that the insurance plan “must provide for insured health services on uniform terms and conditions and on a basis that does not impede or preclude, either directly or indirectly whether by charges made to insured persons or otherwise, reasonable access to those services by insured persons;”

Currently rural British Columbians are significantly discriminated against in accessing emergency services and basic health and wellness services.

In the event of an emergency or life-threatening condition a patient will be transported, often referred as ‘medevac’d’ for medical evacuation, to a facility capable of treating the condition. Quite often, this is done by air transportation due to the significant distance required to receive care. Upon release patients are simply discharged with no consideration or assistance to return to their home community. When medevac’d out due to medical emergencies patients have been discharged from hospital with no funds to return home, no clothing and no support, and too often in a condition where they still require assistance. In the words of a patient “If you can’t afford it? You find a way or else you’re on the streets. The whole thing is literally a panic inducing nightmare and the hospital LITERALLY says they can’t help you and good luck and out the door you go. There really needs to be an advocate for each person to assist.”

In addition, many services are not offered in rural communities such as cancer care, maternity services, diagnostic services, etc. While people and businesses in rural and interior B.C. understand not everything can be offered in every community, it is unequitable that patients in rural, remote areas are expected to cover their own costs. In remote communities, such as Fort Nelson, expectant mothers are required to leave the community 4 - 6 weeks before their due date. This is at an out-of-pocket cost of thousands of dollars, adding stress, taking employees away from work and family, and, if there are other children in the family, additional measures must be considered. There are cases of individuals requiring cancer care choosing no treatment simply because they could not afford the cost related to travelling to another community.

There is a significant burden to business as well as employees are impacted and require more time away including the spouse. It additionally puts an unfair financial burden on families already coping with a stressful situation.

Patients requiring cancer care or other services, even if eligible for the province’s Travel Assistance Program (TAP) are still responsible for all incidental costs. TAP Eligibility is cumbersome and the program is ineffective. The TAP website notes that “The Travel Assistance Program (TAP) helps alleviate some of the transportation costs for eligible B.C. residents who must travel withing the province for non-emergency medical specialist services not available in their own community. TAP does not provide direct financial assistance to patients for travel costs or make travel arrangements for patients. Meals, accommodation, mileage, fuel and local transportation expenses are not included in TAP and are the responsibility of the patient. There is no reimbursement for travel already taken.”

In addition for many rural communities TAP agreements with regional air carriers only offers some discounts and waived flight restrictions. Fares for travel from these destinations are higher and often unaffordable to those who need them the most.

The following is taken from the Province’s Medical Services Plan (MSP) guidelines[1] and are services all British Columbians are entitled to. As it stands today these are only equitably provided if you live in an urban centre. The burden of cost particularly when a medivac is necessary should not be borne by the patient.

• medically required services provided by a physician enrolled with MSP;
• maternity care provided by a physician or a midwife;
• medically required eye examinations provided by an ophthalmologist or optometrist;
• diagnostic services, including x-rays, provided at approved diagnostic facilities, when ordered by a registered physician, midwife, podiatrist, dental surgeon or oral surgeon;
• dental and oral surgery, when medically required to be performed in hospital (excluding restorative services, i.e.: fillings, caps, crowns, root canals, etc.)*;
• orthodontic services related to severe congenital facial abnormalities.

In addition to the above noted challenges there is a growing concern with the outgoing medivac system as well due to an unwillingness / policy from BC Emergency Health Services (BCEHS) to utilize private carriers. Patients are routinely subjected to long wait times and even when alternate services are available they are transported by ground ambulance over long distances. In Fort Nelson a private air charter business undertook the creation of a detailed business case to acquire the appropriate aircraft in order to offer locally-based emergency air transfers, which included in-depth discussions with BCEHS. In 2021, following a commitment from BCEHS for utilization as an ad hoc service provider, they proceeded with the acquisition of a Beechcraft King Air, undertook the retrofits for medical transfers, obtained Transport Canada approval to operate the aircraft in a medical capacity, executed an agreement with BCEHS, and undertook orientation with all local BCEHS staff to ensure readiness for emergency air transfers. Since that time, not one call for service has been made. Due to these inefficiencies patients may wait days for transport to facilities offering a higher level of care. More times than not, these transfers are made by ground (4 hours one way) when a certified aircraft under contract with the same service provider sits 12 minutes from Fort Nelson General Hospital, to take a 50 minute flight to the same destination.

The issues with equitable access to health care has been recognized in many papers and recommendations for many years including the Forestry Ombudsman HEMS Report in 2017[2] and the Select Standing Committee on Finance and Government Services has repeatedly highlighted the need for equitable access to health care in their reports:

1. Budget 2020 Report Recommendation 59
   Provide equitable access to health services in rural and remote communities, including better addressing travel costs and ensuring access to reliable, timely medivac, air ambulance and emergency services and public transportation[3]
2. Budget 2021 Report Recommendation 84
   In consultation with rural communities, establish and fund rural health councils to act as advisory bodies to engage with rural British Columbians and inform decision making on the provision of health care services to meet the unique needs of rural communities. 85. Improve access to health care services in rural, remote and coastal communities by increasing the provision of specialist services and transportation services, and better coordinating and aligning these services.[4]
3. Budget 2022 Report Recommendation 99 and 100
   Ensure British Columbians who require ambulatory medical services outside of their home communities receive timely and reliable return transportation.
   Explore innovative ways to expand health services in communities and through technology to rural, remote, and underserved areas of the province. [See also Recommendation 6 in Equity and Inclusion][5]
4. Budget 2023 Report Recommendation 137
   Improve access to health care in rural and remote communities, including by funding digital health care, exploring the use of physician assistants to extend hospital hours, increasing access to midwives, providing incentives to attract health care practitioners to these communities, and increasing seats and loan forgiveness for students.[6]

THE CHAMBER RECOMMENDS 

That the Provincial Government:

1. Improve medivac services to:
   1. Ensure timely access to care through improved BCEHS services and utilization of contract services.
   2. Ensure British Columbians who require ambulatory medical services outside of their home communities receive timely and reliable return transportation;
2. Improve financial assistance for out-of-community services by;
   1. Providing for at-home maternity care or financial/living assistance if expectant parents have to leave community.
   2. Improving the Travel Assistance Program to provide reasonable expenses for patients who must travel for medical services not provided within their community.
   3. Revise the Travel Assistance Program to allow expenses incurred for travel already taken when emergency medivac takes place.